Surgeon General Concerned About Physician Burnout

If physicians aren't happy, they can't heal others

CLEVELAND -- Medicine is a profession in which emotional well-being is sorely lacking, Surgeon General Vivek Murthy, MD, MBA, told MedPage Today in an exclusive interview here at the annual meeting of the Association of Health Care Journalists.

"The suicide and burnout rate is very high, and this is concerning to me because we're at a point in our country where we need more physicians, not fewer; we need more people entering our profession, not fewer," he said. "If we have people burning out, it really goes against our needs."

"As I think about the emotional well-being for our country, I am particularly interested in how to cultivate emotional well-being for healthcare providers. If healthcare providers aren't well, it's hard for them to heal the people for whom they are they caring."

Murthy talked to MedPage Today before delivering a keynote address to the journalists' group. A press representative from Murthy's office was not present during the interview, but he did insist that he be permitted to leave his recorder running during the interview.

Seeking Serenity

Emotional well-being was one of two healthcare areas that the Surgeon General's office has targeted for this year, Murthy explained, noting that before he became Surgeon General, it was not a topic he thought would be high priority.

But in the months since he has taken office, a growing concern about emotional well-being emerged "from conversations I had with community members, and it is based on the science developed over the years that tells us emotional well-being is an important driver of health."

"People think that emotional well-being is something that happens to you -- things line up in your life, you have the right job, and your health is good, and [you are in] a happy family and in a good relationship and you're happy in your emotional life," he said. "But there's a growing body of science that tells us there are things we can do to develop our emotional well-being proactively, and that in turn can have a positive impact on our health."

Murthy noting that promoting well-being doesn't require reinventing the wheel as there are already programs focused on emotional well-being that have significant outcomes for health and education, but people just don't know about them.

"Sharing success stories is going to be an important part of expanding our prevention efforts," he said.

Prescription Drug Abuse

The Surgeon General's other focus for 2016 is addiction and substance abuse -- a focus that prompted him to decide to write to more than a million physicians, nurses, physician assistants, and dentists (everyone who may be writing opioid scripts) with a personal entreaty to change prescribing practices.

"Nurse practitioners, physicians, and dentists ... they want to relieve suffering, they want to treat pain," said Murthy. "What we have found is that many prescribers were never really trained in how to treat pain safely and effectively. "That's something we want to change."

In his prepared remarks to the AHCJ members, he said, "the opioid epidemic also plays a role in driving forward HIV, Hepatitis C and heroin use."

According to Murthy 80% of heroin users say their addiction began with prescription drugs.

"I see prescribers as being essential part of solution to opioid crisis," he continued. "Unlike many other substances like heroin and other illicits, the majority of supplies of misused prescription opiates are coming from legally written prescriptions. That means doctors, dentists, nurse practitioners, and physician assistants have the power to turn the tide on the opioid epidemic by virtue of their ability to prescribe, and their ability to inform and educate patients. Our goal is to build a national movement in medicine to take on this crisis as one we're uniquely positioned to solve as prescribers."

In addition, the Surgeon General's office will be producing the office's first-ever report on substance abuse, addiction, and health. "The goal of that is to bring together the best possible science on treatment and recovery, so we can equip practitioners, patients, and policymakers with the information they need to promote better health and treat addiction," he said.

E-cigarettes also will be part of the focus, Murthy added. "When I began my tenure as Surgeon General, I started with a listening tour ... We heard from teachers and parents and mayors.

"The people we heard from were frustrated; they said, 'We don't know what to do in e-cigarettes; we're not sure if we should be including them in indoor air laws or not, we're not sure what to tell our kids about e-cigarettes, we're not sure whether to tell people that they're effective for quitting smoking ... That's one of the reasons e-cigarettes will be one of the issues we address in 2016."

Toward a Healthier Nation

Moreover, the Surgeon General's office will continue its promote prevention. "If we want to build a healthier and stronger country, we ultimately have to shift our focus from being entirely on treatment to having a balanced focus on prevention and treatment. Right now, even though most people understand an ounce of prevention worth a pound of cure, that's not reflected in how we invest in health as a country. [Instead] we predominately invest in building hospitals and in research on treatments. That is very important, but we need to do more on the prevention side."

Getting more funding for prevention research and other activities would definitely be helpful, but there are other things that can be done to improve the prevention focus, Murthy said. For example, "one thing that's most helpful is having examples of what's working in other communities. Sharing success stories [is very powerful]."

Murthy himself is known for being a "health nut," trying to eat healthfully and do yoga. "I like desserts and that's my weak point, so I have to be careful about not eating too much in way of sweets," he said. "My wife Alice has been a great partner for me; she helps me get back on track."

Murthy said he has noticed that when he goes out to eat with other people, they are very self-conscious about what they eat, and they look sheepish if they about being interested in the dessert menu. "I have to tell them, 'Order whatever you want. I'm not judging you,'" he chuckled.

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